For the past decade, Juzoor for Health and Social Development, a leading Palestinian health institution, in collaboration with Augusta Victoria Hospital & the Institute of Human Nutrition, Columbia University, has been organizing biennial Nutrition Conferences. These conferences aim to bring together policy makers, practitioners, researchers, and national and international experts in order to contribute to the development, implementation, and monitoring of effective evidence-based strategies, policies, and programs related to nutrition in Palestine. This year, the Sixth Nutrition Conference, “Childhood Obesity: A Time for Action” was inspired by the growing epidemic of non-communicable diseases (NCDs), in particular, diabetes and the increasing rates of obesity among the population, including children. It will be held on October 22-23, 2018 under the patronage of the Palestinian Ministry of Health.

The conference is going to be a joint Juzoor/Augusta Victoria Hospital, Pediatric Society, the Institute of Human Nutrition - Columbia University event with the support of key partners: Ministry of Health (MoH), MoH Nutrition Department, Ministry of Education, Nutrition National Committee, UNRWA, World Health Organization, and UNICEF.

Obesity among children and adolescents

Optimal growth and development of children is a basic human right and a clear objective of healthcare systems [1]. Obesity, including pediatric obesity, is increasing worldwide, with the most rapid rises occurring in low and middle income countries [2]. The worldwide prevalence of obesity has nearly doubled between 1980 and 2008 [3]. While the rising trends in children's and adolescents' BMI have plateaued in many high-income countries [4], it has accelerated in developing countries [5]. The world maps below present the age-standardized prevalence of obesity among girls and boys 5-19 years of age, by sex and country in 2016. As shown in the world maps, in the Eastern Mediterranean Region, the status of overweight and obesity has reached an alarming level. Based on a study among adolescents in the Middle East in 2004, between 3%–9% of preschool children and 12%–25% of school children were overweight and obese [6].

In addition to genetics and metabolism, some of the factors associated with obesity in children and adolescents are: long periods of watching television or using the internet, physical inactivity, community and neighborhood design and safety, high intake of fast foods, an increase in food intake outside the home [7, 8], short sleep duration, and poor sleep quality [9]. Children and adolescents who do not get enough sleep have a higher risk for many health problems, including obesity, diabetes, poor mental health, and injuries. They are also more likely to have attention and behavior problems, which can contribute to poor academic performance in school [10].

Childhood and adolescent obesity has adverse psychosocial consequences and limits a child’s academic achievement [11]. Children with obesity are bullied and teased more than their normal weight peers and are more likely to suffer from social isolation, depression, and lower self-esteem [8]. Children who are overweight and obese are likely to be obese in adulthood and more likely to acquire non-communicable diseases (NCDs) at a younger age [12]. By 2020, it is predicted that NCDs will be the cause of 7 out of every 10 deaths in developing countries [13]. By 2030, NCDs will be responsible for virtually half of the global burden of disease in the developing countries. Knowing the risk factors for chronic disease means that approximately 80% of premature heart disease and stroke, 80% of Type 2 diabetes and 40% of cancers are preventable [13].

Based on the 2030 Agenda for Sustainable Development, governments must deliver on their time bound promise to reduce, by one-third, premature mortality from NCDs. Because many policy commitments are not being implemented, countries are not on track to achieve this target [2]. There is no strategy to prevent and control obesity in the health plans of most (if not all) the countries of the Region [6]. Whereas much public health measures have been taken to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to combat obesity [14]. There is no excuse for inaction, as there are evidence-based solutions. Obesity - the primary risk factor for NCDs - is considered a public health crisis that severely impairs the health and quality of life of people and adds considerably to national health-care budgets [5]. WHO’s global business case for NCDs showed that low- and lower-middle-income countries put in place the most cost-effective interventions for NCDs, by 2030, they will see a return of $7 per person for every $1 invested [2].

Nutrition challenges in Palestine

The continuing political crisis and conflicts, the severe restrictions on the movement of people and goods, and high food insecurity rates continue to affect the livelihoods of Palestinians, with adverse consequences for their health status. The unemployment rate in Palestine is 13.2% in the West Bank and 48% in Gaza [15]. In 2018, an estimated 13% of the population in the West Bank and 39% of those in the Gaza Strip were food insecure [16]; which means 1.6 million food-insecure Palestinians are in need of food assistance. Furthermore, dependence on donor funding causes financial uncertainty, which affects the development of adequate, high quality and sustainable healthcare interventions targeting all children.

Double burden of Malnutrition

Palestine is increasingly affected by the double burden of malnutrition: the persistence of under-nutrition, combined with a rapid rise in overweight and obesity. Between 2010 and 2014, there was a 60% increase in the prevalence of overweight among children under 5 [17]. Based on the UNICEF micronutrient survey 2013, 16-27% of children under 5 years had mild anemia, and 16–27% had moderate anemia [18].

There are also concerned levels of overweight and obesity among school children. In a study among 1484 children enrolled in the UNRWA and government schools in the West Bank in 2009, the prevalence of stunting was 7% and underweight 3% [19]. Over 12% of students were overweight and 6% obese. Based on the study, children start school with moderate stunting and underweight, but by the 9th grade, overweight and risk of overweight start to be observed, especially among girls [19]. This is in line with the National Nutrition Surveillance report 2014 that showed that the prevalence of overweight and obesity among school children was 18.6% and 7.24% respectively [20].

The increasing problem with childhood obesity requires particular care since there is no National Strategy in Palestine targeting childhood obesity. There is an urgent need for action to strengthen control and prevention measures to counter the rapid rise of NCDs. In 2016, in Palestine, NCDs, including diabetes, were responsible for 57% of mortality . Although there are national programs to address childhood obesity, like healthy school canteens and public health measures to restrict the adverse marketing of breastmilk substitutes, such programs are limited.

Given its cross-cutting nature, nutrition needs to be mainstreamed into the different programmatic areas; taking a life cycle approach.

Conference objectives

The core aim of the Sixth National Conference is to provide an opportunity for the delegates to meet, interact and exchange new ideas in evidence based interventions to combat childhood and adolescent obesity.

Discuss the current situation in Palestine including the nutritional status of children and adolescents.

Review current Palestinian nutrition and NCDs programs in terms of impact, challenges and lessons learned.

Provide a platform to discuss the double burden of nutrition and identify important challenges to be considered when planning a national strategy to prevent childhood obesity in Palestine.

Mobilize resources to implement drafted policies to combat obesity. Enhance the coordination and cooperation of various actors and to assess how to scale up nutrition programs and jointly tackle childhood obesity.

Expected outcomes

Expose Palestinian institutions and professionals to the latest evidence regarding science-based nutrition and NCD programs and research findings.

Bring to the table other stakeholders to address obesity among school children, in addition to the Government: civil society, municipalities, universities, non-governmental organizations including youth organizations.

Foster networking and exchange of know-how amongst institutions and professionals, national and international.

Make the response to the obesity epidemic an urgent public health priority and coordinate the public- and private-sector response.

Pave the way to developing a National Strategy and action plan in Palestine targeting childhood obesity.

Initiate the implementation of policies, by stimulating a policy dialogue involving several stakeholders.

About Juzoor

Juzoor for Health & Social Development was founded in 1996 by a team of health and development professionals.

Juzoor is Palestinian non-governmental organization based in Jerusalem working at the national level, dedicated to improving the health and well-being of Palestinian families and promoting health as a basic human right.